Provider Demographics
NPI:1346202025
Name:SWADE, JOHN PAUL II (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:SWADE
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 RAVINE STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DRAVOSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15034-1012
Mailing Address - Country:US
Mailing Address - Phone:412-466-9100
Mailing Address - Fax:412-466-9485
Practice Address - Street 1:523 RAVINE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:DRAVOSBURG
Practice Address - State:PA
Practice Address - Zip Code:15034-1012
Practice Address - Country:US
Practice Address - Phone:412-466-9100
Practice Address - Fax:412-466-9485
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007537L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU76478Medicare UPIN